GREAT NORTHERN PHYSICAL THERAPY P: 406-586-4678

Pelvic Pain and Physical Therapy

Did you know that upwards of 8% of women and men experience pelvic pain? I don’t know about you but that seems like a lot of people to me! Pelvic pain is sometimes hard to talk about and can seem scary so let’s dig into what it means to have pelvic pain and what PT can do to help. 

Pelvic pain is a broad term to describe any pain in the pelvic floor or surrounding tissue. Some of the common types of pelvic pain are dyspareunia, interstitial cystitis, endometriosis and pudendal neuralgia. Getting a diagnosis like this from your doctor can be scary; so let’s break down what pelvic floor PT can do to help.

Dyspareunia is a general term for pain with intercourse. It can be pain that happens before, during or after intercourse. The pain can happen with penetration in both superficial and deep layers of the pelvic floor or it can be pain on the exterior structures. Dyspareunia can be caused by a variety of different things from lack of lubrication to tightness in the pelvic floor muscles. The good news is that something physical therapy can help with! A pelvic floor physical therapist can evaluate the pelvic floor muscles and determine if doing some treatment such as stretching could be helpful for you!

Interstitial cystitis is a chronic bladder condition resulting in pain in the bladder. The irritated bladder walls which can cause scarring and stiffening of the bladder over time. Physical Therapy can be helpful in conjunction with treatment from your urologist/primary care practitioner to help decrease pain associated with the disease. Physical therapy can include discussing bladder irritants; pelvic floor retraining and/or coordination training of the pelvic floor.

Endometriosis is an often painful disorder in which tissues similar to endometrial tissue grows outside of your uterus. Physical therapy can be helpful in managing some of the painful symptoms associated with endometriosis in conjunction with treatment from you OBGYN or PCP. Physical therapy can’t change the fact that you have endometrial tissue in places it doesn’t normally reside, but it can help with managing the pain through stretching, myofascial work, and soft tissue mobilization.

Pudendal Neuralgia is a long-term pelvic pain that originates from damage or irritation of the pudendal nerve which is a main nerve in the pelvic region. Irritation to the nerve can be caused by compression, prolonged stretch, or even a physical trauma. It is a common injury in men and women who bike a lot due to the prolonged compression of the bike seat along that nerve. Physical therapy can be helpful to address the irritated tissue and may involve some stretching, nerve glides and soft tissue work. 

Pelvic pain is complicated and encompasses many different diagnoses. At Great Northern Physical Therapy we believe no man or woman should have pain with intercourse, exercise or in any part of the pelvic floor. If you have any of these symptoms or wonder if physical therapy is something that could be helpful for you, give us a call, we’d love to help!

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Breathing and Your Pelvic Floor

Feb 13, 2023

The pelvic floor is certainly a hot topic of conversation for many men and women. Specifically, people begin to focus on their pelvic floor when they are having incontinence, urgency/frequency, prolapse, or pain associated with going to the bathroom or having sex. These are all issues related to pelvic floor dysfunction. But, what many don’t realize, is that your pelvic floor is also integral in one of our most basic functions: breath.

The diaphragm, our respiratory muscle, is located at the bottom of the ribcage. At rest, the diaphragm is a domelike shape, and with inhalation the diaphragm muscle contracts and drops downward toward your pelvis. This downward motion is followed by a shifting downward of internal organs, into the pelvic bowl. The pelvic floor muscles and fascia make up the bottom of the pelvic bowl. So, with this downward force during inhalation, the pelvic floor muscles also descend or stretch slightly downward. Immediately following inhalation and pelvic floor descent, is exhalation, and similarly, the pelvic floor follows the diaphragm as it rises upward to a resting position. This synchronous rising and falling of the diaphragm and pelvic floor is often referred to as the “piston effect”.

Not to be left out, the lower abdominal muscles (transverse abdominis) also contribute to this synchronous movement pattern. Working together by relaxing and stretching with inhalation and a “belly breath”, and tightening and drawing inward slightly with exhalation. In this way, the diaphragm, abdominals, and pelvic floor make up an abdominal cylinder that modulates intra-abdominal forces and pressure changes.

When this cylinder isn’t coordinating well together, or if there is tightness or weakness within the system, we see common musculoskeletal complaints: low back pain, SIJ pain, poor stability through the back and pelvis, hip pain, pelvic pain, incontinence, urgency/frequency of urine or stool, prolapse, poor posture, balance issues, and intolerance to exercise.

Our pelvic floor physical therapists can help evaluate these movement patterns and coordination of these systems, and create a treatment approach specific to you and your individual challenges.